Renal papillary necrosis
|Renal papillary necrosis|
|Classification and external resources|
Signs and Symptoms
Renal papillary necrosis presents acutely with gross hematuria, flank pain, and tissue fragments in the urine. It may also include non-specific findings such as fever and chills. Alternatively, it can also present in a chronic form that remains asymptomatic and is diagnosed incidentally.
Any condition that involves ischemia can lead to renal papillary necrosis. The four most significant causes are sickle cell disease or trait, analgesic use, diabetes mellitus, and severe pyelonephritis.
A mnemonic for the causes of renal papillary necrosis is POSTCARDS: pyelonephritis, obstruction of the urogenital tract, sickle cell disease, tuberculosis, chronic liver disease, analgesia/alcohol abuse, renal transplant rejection, diabetes mellitus, and systemic vasculitis. Often, a patient with renal papillary necrosis will have numerous conditions acting synergistically to bring about the disease. 
Analgesic nephropathy is a cause of renal papillary necrosis. The damage is cumulative and most patients of renal papillary necrosis would have ingested at least 20 kg of analgesics in the past. The risk is higher for phenacetin (which has been withdrawn from the market in the United States) and paracetamol (acetaminophen) compared to aspirin and other NSAIDs. Combination analgesic products, such as Goody's, also have a high risk of causing papillary necrosis.
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- Powell, Christopher. "Papillary Necrosis". Medscape Reference. Retrieved 10 Nov 2011.
- "Renal Pathology". Retrieved 2008-11-26.